Recent Posts

Pages: [1] 2 3 ... 10
1
GENERAL / The 9 best ways to keep your smartphone secure
« Last post by agate on May 18, 2025, 08:40:22 pm »
From IDX (May 13, 2025)--"The 9 best ways to keep your smartphone secure":


https://www.idx.us/knowledge-center/the-9-best-ways-to-keep-your-smartphone-secure?utm_medium=email&utm_source=nurture&utm_campaign=N204_MembersEngaged90&utm_content=article-two
2
MS - RESEARCH AND NEWS / (Abst.) Early phase MS patients deficits compared to matched healthy controls
« Last post by agate on May 17, 2025, 09:23:28 pm »
From Neurorehabilitation and Neural Repair (May 2025)--"Early phase multiple sclerosis patients present substantial deficits in physical-, cognitive-, and patient-reported outcomes compared to matched healthy controls":


https://journals.sagepub.com/doi/abs/10.1177/15459683251318246#tab-contributors
3
NEWS / New England Journal of Medicine gets letter from DOJ
« Last post by agate on May 16, 2025, 09:23:08 pm »
From MedPage Today (April 24, 2025)--"NEJM gets letter from DOJ":


https://tinyurl.com/2sejm7z4
4
MS - RESEARCH AND NEWS / (Abst.) Group-based cognitive remediation and behavioral approaches to intervention in MS
« Last post by agate on May 15, 2025, 09:19:57 pm »

These researchers used an intervention of some kind with some people with MS and apparently got positive results. Cognitive behavioral therapy and cognitive training were used to cheer these people up.


From PubMed (May 15, 2025)--"COMBAT-MS (group-based cognitive remediation and behavioural approaches to intervention in multiple sclerosis)":


https://pubmed.ncbi.nlm.nih.gov/40367684/


AI has this to say about Australia-based COMBAT-MS:


Quote
COMBAT-MS is a program developed in Australia by the Brain and Mind Centre at The University of Sydney. It's the first program to combine psychological strategies targeting both thinking skills and general well-being in people with Multiple Sclerosis (MS). The program is a randomized controlled trial that investigates the effects of group-based cognitive behavioral therapy (CBT) and cognitive training (CT) on cognitive and psychosocial outcomes in people with MS.
5
TREATMENTS / (NEJM editorial) Progress toward mitigating disability progression in MS
« Last post by agate on May 14, 2025, 03:46:03 pm »

This should provide access to the full article. From the New England Journal of Medicine, editorial by Peter A. Calabresi, MD (May 14, 2025)--"Progress toward mitigating disability progression in multiple sclerosis":


https://www.nejm.org/doi/full/10.1056/NEJMe2503891?query=TOC


If that link doesn't get you there, here is the editorial (emphasis added):



(New England Journal of Medicine Editorial) "Progress toward Mitigating Disability Progression in Multiple Sclerosis" by Peter A. Calabresi, MD:

Multiple sclerosis is the most common cause of progressive neurologic disability in young adults. There had been no treatments for the disease, except for glucocorticoids, which were used for more than 25 years before they were shown to reduce the duration and severity of acute relapses but to have no benefit with respect to the accumulation of disability. Then, in 1993, interferon beta was shown to reduce the frequency of relapses and the number and area of lesions on T2-weighted magnetic resonance imaging (MRI) of the brain.

Since then, more than 20 additional drugs have been approved for multiple sclerosis, predominantly for relapsing forms of the disease. These compounds mostly modulate the peripheral immune system and minimally target existing lesions in the brain and meninges. As a result, persons with multiple sclerosis who are treated with these drugs have few new clinical exacerbations; however, the lesions that form before treatment often remain chronically active and continue to cause progressive tissue damage and disability. The pathogenesis of secondary progressive multiple sclerosis, which is characterized by insidious disease progression in the absence of new infiltration of peripheral immune cells, involves reactive gliosis (microglia and astroglia), chronic demyelination, and neuroaxonal injury.

In this issue of the Journal, three landmark clinical trials provide evidence that a brain-penetrant Bruton’s tyrosine kinase (BTK) inhibitor, tolebrutinib, may slow disability progression in multiple sclerosis. Investigators report the efficacy of tolebrutinib in relapsing multiple sclerosis (the GEMINI 1 and GEMINI 2 trials) and secondary progressive multiple sclerosis (the HERCULES trial).

BTK inhibitors are being tested in several trials in immune-mediated diseases because the enzyme is important for B-cell activation. BTK is also expressed in myeloid lineage cells, including reactive microglia. Tolebrutinib was designed to be brain-penetrant to suppress B cells both in the periphery and the meninges, as well as in activated microglia at the edge of chronic active lesions.

The HERCULES trial, which recruited participants with secondary progressive multiple sclerosis and no recent clinical relapses, assessed the efficacy of tolebrutinib as compared with placebo in the absence of classic inflammatory disease. The percentage of participants who had confirmed disability progression that was sustained for at least 3 months and for at least 6 months was smaller in the tolebrutinib group than in the placebo group. The rate of new or enlarging lesions on T2-weighted MRI was lower in the tolebrutinib group than in the placebo group, a finding that suggests that there was a component of active inflammation in this trial population, despite attempts to recruit participants with noninflammatory progressive multiple sclerosis.

The GEMINI trials were active-comparator trials for ethical reasons (because there are effective therapies known to reduce relapse rates).

The two trials compared tolebrutinib with teriflunomide and involved participants with relapsing forms of multiple sclerosis. There was no significant difference between the two drugs in the annualized relapse rate or the number of new or enlarging lesions on T2-weighted MRI. This result is consistent with the results of another recently completed trial of a BTK inhibitor (evobrutinib) for the treatment of relapsing multiple sclerosis that acts in the periphery. Nonetheless, despite the absence of any additional beneficial effect on acute inflammation-mediated clinical events or acute inflammatory activity on MRI (as compared with teriflunomide), there was apparent slowing of confirmed disability progression with tolebrutinib, which, when viewed in the context of the HERCULES trial, suggests that tolebrutinib may target chronic inflammation in the central nervous system.

Caution in the interpretation of these results is indicated, pending further data analyses from these trials and ongoing studies of BTK inhibitors in progressive multiple sclerosis. Progression independent of relapse activity has been widely cited as an important outcome in studies in multiple sclerosis, but it does not capture subclinical MRI activity and accumulated lesion load on T2-weighted MRI that are known to be more prevalent than relapses and to predict future disease progression. Progression in the absence of relapses and new lesion formation on MRI is more sensitive in determining whether the mechanisms underlying disease progression are new inflammatory infiltrates (new or gadolinium-enhancing lesions) or the insidious neurodegenerative process for which we need new therapies.

Participants in the HERCULES trial were enrolled because they were having progression despite previously receiving available disease-modifying therapies for multiple sclerosis. However, more than 70% of the participants were only receiving first-line therapy, and in many cases these drugs are only partially effective at reducing inflammation. Furthermore, for patients who are receiving stronger therapies, the withdrawal of these therapies could lead to delayed reactivation of inflammatory disease. A total of 13% of the participants had gadolinium-enhancing lesions at baseline, and new lesions on MRI were observed in participants during the trial. Therefore, some of the observed effects on disability progression may be attributable to antiinflammatory effects akin to what has been seen with existing multiple sclerosis drugs when assessed in persons with progressive multiple sclerosis who have superimposed relapses or MRI activity. Indeed, the reduction in new and enlarging lesions with tolebrutinib could support this notion. The absence of an apparent effect of tolebrutinib on MRI activity in the GEMINI studies argues against the possibility that new lesions on T2-weighted MRI were the sole driver of disease progression in the HERCULES trial. BTK is expressed at the edge of chronic active lesions, which can be assessed with the use of susceptibility-weighted imaging to detect iron-laden microglia in phase rim lesions, which are known to predict worse outcomes in multiple sclerosis.

Analysis of the susceptibility-weighted imaging data in these trials may help discern whether there was a greater treatment effect in the participants with phase rim lesions than in those without them and would strongly support the concept that tolebrutinib was indeed, in part, targeting activated microglia in chronic active lesions.A serious safety concern, related to BTK inhibitors as a class when tested in persons with multiple sclerosis, has been markedly elevated levels of aminotransferases. These events led to the Food and Drug Administration placing a temporary hold on all the ongoing BTK inhibitor studies until it was determined that the vast majority of the most serious cases were occurring in the first 12 weeks of treatment but were reversible if detected rapidly through more frequent laboratory testing. If these data are replicated in ongoing studies, and BTK inhibitors are approved for progressive multiple sclerosis, clinicians will need to grapple with when and how to use these drugs, which may have less robust antiinflammatory activity than the available monoclonal antibodies, but which could be directly targeting the pathogenesis of insidious progression in persons with multiple sclerosis. Clinical trials are warranted to evaluate the added benefits of initiating combination therapy from the onset of disease, which could enable targeting of both inflammation and neurodegeneration.

[Reference notes omitted]
6
COPAXONE, GLATOPA (glatiramer acetate) / New generic version of Copaxone from Zydus has FDA approval (Glatiramer Acetate Injection)
« Last post by agate on May 13, 2025, 02:05:21 pm »
I'm not sure why the world needs so many generic versions of glatiramer acetate but there's a new one that has just been approved. Apparently its name is Glatiramer Acetate Injection. The other two generics I'm familiar with are called Glatopa and just "glatiramer acetate." Or you could just go with the brand-name version, Copaxone.


From BusinessWire.com (May 8, 2025)--"Zydus Receives Final Approval from USFDA for Glatiramer Acetate Injection, the Generic Version of Copaxone 20mg/ml, 40mg/ml, Single-Dose Prefilled Syringes":

https://tinyurl.com/y6vppaxc
7
THE PRACTICAL SIDE OF BEING MULTIPLY SCLEROSED / Setting your bedroom up for safety
« Last post by agate on May 12, 2025, 09:31:07 pm »
From Consumer Reports (April 28, 2025)--"How to Set Your Bedroom Up for Aging in Place":


https://www.consumerreports.org/home-garden/home-safety/how-to-set-your-bedroom-up-for-aging-in-place-a1114833383/?EXTKEY=NH55HTHE2&utm_source=acxiom&utm_medium=email&utm_campaign=20250511_nsltr_health&utm_nsltr=health&utm_segment=nbp
8
NEWS / Trump's first 100 days...
« Last post by agate on May 11, 2025, 03:33:04 pm »
Several highly respected doctors were asked to evaluate the first 100 days of the Trump administration. Not one of them gave a favorable assessment.


From MedPage Today (May 5, 2025)--"Trump's First 100 Days: Gawande, Offit, Hotez, and Others Weigh In":

https://tinyurl.com/34dkf34z
9
THE PRACTICAL SIDE OF BEING MULTIPLY SCLEROSED / Which doctors see the fewest patients per hour?
« Last post by agate on May 10, 2025, 08:38:31 pm »
From Med School Insiders (April 25, 2025)--"Which Doctors See the Fewest Patients Per Hour?"




https://medschoolinsiders.com/pre-med/patients-per-hour/
10
MS - RESEARCH AND NEWS / (Abst.) Cognitive test performance and disease progression in primary and secondary PMS...
« Last post by agate on May 09, 2025, 03:13:03 pm »

The abstract concludes with this statement:


Quote
However, the possibility that current cognitive measurement instruments are psychometrically flawed remains, warranting further research.


It looks as if the many tests of cognition that are being used aren't so very dependable when it comes to evaluating people with MS.

From PubMed (May 9, 2025)--"Cognitive test performance and disease progression in primary and secondary progressive multiple sclerosis: An analysis of the SPRINT-MS study":


https://pubmed.ncbi.nlm.nih.gov/40338019/
Pages: [1] 2 3 ... 10